The People's Perspective on Medicine


Carbamazepine can be helpful in controlling seizures, but it is crucial to understand the potentially serious side effects it may cause.


Carbamazepine (Carbatrol, EquetroTegretol) is prescribed for the control of a variety of seizure disorders.

It is also used as a special kind of pain reliever for trigeminal neuralgia which produces severe facial pain.

Although the Food and Drug Administration has not approved carbamazepine for other uses, doctors sometimes prescribe it for a variety of psychiatric disorders, alcohol withdrawal and restless leg syndrome.

Side Effects

Side effects associated with carbamazepine include dizziness, drowsiness, incoordination, unsteadiness, mood changes, nausea, vomiting, stomachache and loss of appetite.

Other adverse reactions to be alert for include dry mouth, constipation, rash, itching, fatigue, headache, blurred vision, ringing in the ears, double vision, numbness and tingling of the hands and feet, swollen legs and feet, heart failure, high blood pressure, fainting and sexual problems. Heart rhythm abnormalities, lung reactions, pancreatitis and low sodium (hyponatremia) are serious complications of carbamazepine.

Carbamazepine can rarely cause failure of the bone marrow to produce blood cells appropriately. Symptoms include unexplained sore throat with fever and chills, mouth ulcers, and aching joints and muscles. Since this is a life-threatening reaction, such symptoms should be reported immediately to a health care professional.

Skin reactions such as Stevens-Johnson syndrome may also occur. These, too, are potentially life threatening and call for immediate medical attention. Genetic testing prior to starting on carbamazepine may predict patients at higher risk for this reaction, which is more common in people with Asian ancestry.

Blood tests are needed to detect kidney failure, liver enzyme elevations, and blood disorders. Report any symptoms to your physician immediately.


A large number of over-the-counter and prescription medications may interact with carbamazepine in a dangerous way.

Some drugs, such as clarithromycin, erythromycin or propoxyphene (Darvon), can make carbamazepine much more toxic, with dangerous blood levels building up surprisingly quickly.

Other anticonvulsants interact with carbamazepine in complicated ways and may even reduce its effectiveness. A person who needs several anticonvulsants should be under the care of an experienced epilepsy specialist.

In addition, carbamazepine can interfere with the benefits of many other compounds.

Just a few of the many drugs that interact with Tegretol include several different kinds of antidepressant, the blood thinner warfarin (Coumadin), the ulcer drug cimetidine, the heart and blood pressure pills diltiazem or verapamil (Calan SR, Covera-HS, Verelan), and certain antibiotics such as tetracycline, Vibramycin and INH.

Other medications that may cause problems include antiviral drugs used to treat hepatitis or HIV, MAO inhibitor antidepressants, the anticancer drug procarbazine (Matulane) and the antifungal drug voriconazole (Vfend).

The herb St. John’s wort might speed elimination of carbamazepine from the body, which could reduce its effectiveness.

Psyllium can affect the absorption of carbamazepine; if you take it, it is best to do so at least an hour after taking the anticonvulsant.

Do not take any other medications or herbs without first checking with your physician and pharmacist.

Special Precautions

Some people should not take carbamazepine.

Elderly patients may be especially susceptible to side effects of confusion, agitation or even psychosis.

People with glaucoma, heart disease, kidney problems, liver damage, lupus or a history of blood disorders should take Tegretol only under close medical supervision, if at all.

This medicine can produce a dangerous anemia or blood disorder that can be life-threatening. Periodic blood tests, particularly during the first two months, are crucial to reduce the risk of this hazard.

Pregnant women should use carbamazepine only after careful evaluation and discussions with an obstetrician.

Anticonvulsants in general have the potential to cause birth defects.

Taking the Medicine

Carbamazepine is best absorbed when it is taken with meals. This should also reduce the likelihood of stomach upset.

To maintain its effectiveness, this medicine should be stored in a tightly closed container away from heat and humidity.

Stopping it abruptly could lead to seizures and should be avoided.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I was taking tegretol 200 mg morning and night, 100mg at lunch timeI was diagnosed with hyponatreamia 2 weeks ago. 5 weeks prior to this had severe abdominal pain, thought to be gall stones or pancreatitis. Due to the nausea I was also taking stemitil. I was given zopiclone for insomnia, which I took very sparingly.

At hospital on discharge they told me I could no longer take a long list of medications, as I was likely to have the same problems again. No one warned me of the withdrawal symptoms. I was stopped immediately on the doses of tegretol, piriton, stemitil, omepreazole, ferrous fumerate, solpadol.
I had also been taking b vitamins, blood builder, magnesium and calcium and vit d supplements. There were no warnings about not taking b vitamins at the same time as tegretol.

Other people became aware that I was not behaving normally: confusion, tiredness, slurred and slow speech with word-finding difficulties, agitation, quick to anger, balance problems which led to falls. All this when the drug was changed by pharmacy to generic brand. No one picked up on this as a catalyst to the gradual onset of symptoms untill I became very unwell.

Personally I thought I was fine. I couldn’t understand why I had to go to hospital. I thought they would just swap my meds and send me on my way. My blood level prior to getting admitted was 123 for sodium. The blood test on admission was 121 for sodium. This is too low. I had low blood pressure too which was not helping matters. Two weeks out, and I’m still having headaches, feel shaky, insomnia, itchy rash, tingling in fingers and toes, and balance issues.

I’m still restricted on fluids until I get latest blood test results (due tomorrow) but have been having symptoms of dehydration since being in hospital on a 1 lr fluid per day restriction, and on the last day they put it up to 1.5ltr. My skin is still a bit scaly, dry, and peeling. The itchy rash still comes and goes during the day. It’s still taking a while for pinched skin to go back flat.

Please be aware that you can get very sick, very quickly and not be aware yourself.
I’m now suffering facial nerve pain again. Some days I am unable to wear my specs. Can’t get into pain management until November. Dental hospital in July.

Feel like I’ve gone from the frying pan into the fire 😥

I was prescribed carbamazepine AND amitriptyline some 25 to 30 years ago for Trigeminal Neuralgia caused by seriously botched sinus surgery. I was never sure which of the drugs were effective, but it really didn’t matter. The TN was tamed. With time, I was able to slowly reduce taking both drugs and got down to 20 mg of amitriptyline and 200 mg of carbamazepine.

Recently, I went to Europe for three weeks and after a week I discovered that when packing I had confused another drug (amlodipine) with carbamazepine pills (both white and similar in size) and was taking 150% doses of the former instead of two of the latter! I had not packed any carbamazepine!
I immediately stopped the 150% dosage of amlodipine. To my huge surprise my TN had not flared up nor did I have any “out of body” or other withdrawal symptoms from stopping carbamazepine. How long have I taken carbamazepine when I apparently did not require it to control my TN? I’ve now not taken any carbamazepine for four weeks, and my TN has not returned–not even a small flash of pain.

Has my TN gone away for good or is the amitriptyline doing the heavy lifting? I’ll talk to my primary physician to determine whether I should now try reduce amitriptyline to get the answer. A side benefit of not taking carbamazepine is that I don’t have shaky hands and can drink a glass of water holding the glass in one hand instead of two.

Sometime it’s nice to know other people have the same problem,so it’s good to realise your not the only one.

I had to increase my carbamazepine to 1200mg due to a return of
trigeminal neuralgia.
This time it mimicked heart disease. It’s the same as high doses of
gabapentin. When I weaned myself from gabapentin a few years
ago all of these symptoms disappeared. The symptoms are, increased
heart rate, fatigue, some shortness of breath, and knee joint pain.
I now have to carefully wean myself off of carbamazepine.
I am 80 years old.

I had sudden onset of Trigeminal Neuralgia. If I go on Carbamazepine, will it be forever?

You should consult with your doctor, preferably someone knowledgeable, like a neurologist, about this. I am person with trigeminal neuralgia who will give his opinion. Generally, trigeminal neuralgia is:
Permanent with possible early temporary remission
Treated best with Carbamazepine (Tegretol)
Tegretol often causes negative side effects
Tegretol may lose effectiveness over time
microvascular decompression (MVD) is most effective cure
MVD is brain surgery and has risks
Look for experienced neurosurgeon who has done many MVD surgeries
I got MVD surgery and am completely cured, no longer need Tegretol, and am very happy I did it. Scary but worth it.

I have central nerve pain and I’m on gabapention and tramadol with only a little relief. I stay very sleepy so when my neurologist prescribed tegratol I am very hesitant to take it. I am concerned over drowsiness and also most of the drug interactions are common medicines that I usually take. I’m a little confused that it treats trigeminal neuralgia but I had a stroke and have central nerve pain. Should I take this drug.

Tegretol is an anti seizure medication also used to treat Trigeminal Neuralgia. It can cause many negative side effects including drowsiness. Check with your neurologist about all possible medications you might use. There maybe other choices.

Started tegretol xr 3 yrs ago due to a tonic clonic seizure and was well controlled. Reducing the dosage helps in headache and weaknesses. Low red and white blood cells are the only side effect which is still under monitoring. Fibro worsen over the years where doctors claimed it’s unrelated.

My niece has taken 400mg tegretol for 20 yrs-no one seems concerned she can’t drink a glass of water without 2 hands and then it spills. I also see tremors in her mouth/jaw with lateral and shaky movement. She has weak spells where she can’t concentrate, hands shake terribly?? Tegretol

My sister has been taking Epitol for two years I have watched her Heath go down. She has about every side effect I have read on epitol. Now I fear they or going to diagnose her with Parkinsons. Most of the Drs are not familiar with Epitol and they will not listen to my concern. She even takes medicine you’re not to mix with Epitol. Don’t know who to talk to or go to I’m afraid of what will happen to my sister if I can’t get her off of it. Any suggestions I would be at your mercy….
People’s Pharmacy response: Epitol is carbamazepine, an anticonvulsant. The doctors should be familiar with carbamazepine, as it is an old drug. While it has plenty of side effects, we’ve not heard that it leads to Parkinson’s disease.
If she needs to get off it, she MUST do it under medical supervision. Otherwise, she could have seizures.

I’ve been taking epitol for 3 months and already, I’ve gone from a mild tremor that started in my left fingers to tremors in both hands. I have one documented case of parkinson’s in my family so I know the symptoms. I found this post just by googling, epitol shaking hands to see if it is one of the minor symptoms of epitol. I wear a hoodie most often so I can hide that my hands shake, and it makes typing difficult at work. I used to type at 75-80 words a minute, but now with the hands shaking, I repeat letters or hit different letters so often, I am down to 30 on a good day. I’m not saying I’m developing parkinson’s but the symptomology is as far as shaking is eerily similar.

I have taken Tegretol for over 30 years. It has it’s drawbacks, but does the job. Now that I am getting old, the unsteadiness side effect, and the age can be a problem. Taken with Lyrica is what I am on, the expense gets to you. Lyrica in generic sure would be nice.

I’ve been on 400mg Tegratol for 10 months for periodic seizures due to a brain injury suffered in 2005. Historically an athlete, now I’m reduced to feeling tired all of the time, lightheaded, memory problems, dehydration, and weakness. My most recent doctor tried to switch me to Lamictal but I had an adverse reaction to it. Next step Mayo clinic? Hard to live this way.

I have had Trigeminal Neualgia since 1993. Doctors did not know what it was until 1999.
I have been on carbamazepine [Tegretol] since 2001, and Baclofen when needed. These meds had been a life saver until Dec.2012. Then the meds stop working. I had an operation: microvascular decompression of the trigemial nerve.

Hi Linda & all,

I’ve had a daily chronic headache/migraine for 9 years – woke up to a blinding headache one day when I turned 30 and have lived with it to various degrees ever since – with no diagnosis or responsive treatment. Recently diagnosed as Trigeminal Neuralgia and prescribed Tegretol which I’m just starting. My question is regarding the operation. Did you have a special/specific MRI to locate the compressed nerve and was the microvascular decompression successful or are you back to chronic pain? I have read that some surgeries do not solve the chronic pain long term. After almost a decade of this debilitating pain, I am searching for a solution, not more medication. Thanks to anyone with answers.

My Dr said it is – for the headache I initially got while on tegretol. He said I can take any of the NSAIDs. I would check with your Dr if you planned long term regular use of it.

You need to go to dr so that he can try another sort of medication that doesn’t have those effects.

to control a seisure disorder I have used 1600 mg Tegretol XR daily for 20 years. My Rx was changed to the generic, Carbamazepine ER, so that the insurance company would cover the cost. I began to experience serious weight gain and felt drugged. I have reduced the dosage to 1200 mg daily and my blood level has stayed the same. I still do not feel better. Have other people had problems with the generic?

Yes, years ago I had problems with the generic of Carbatrol (another version of carbamezapine.) It was not the same at all as the brand name. I have always asked for brand name ever since.

After 3 years of occasional pain (once a year) I have finally found a doctor who said I likely have trigeminal neuralgia. This after trips to the dentist, sinus specialists etc. They all just threw antibiotics and pain killers at me (none of which worked ). I had to diagnose myself before a doctor would listen. Anyway does everyone have pain constantly? Does it gradually last longer? Right now I only have it for about a month at a time.
Also I have been on carbamazepine for almost a month at only 600mg/day and I still can’t function without nausea and dizziness, is there another drug that works without these side effects? I guess the side effects are far better than the pain but trying to run a household with two busy kids isn’t easy!

after several of occipital head pain and analgesic did nothing my GP sent me to neurologist my pain is very extreme like thunderbolts last for 6 days then goes for another 5/6weeks MRI taken and waiting for results now on Tegetol 200mgs twice a day yep it makes me aZombie dizzy weak stupid but I cannot take higher dose so take 100 am 100 2pm 200 at 8pm as I need to be able to get on with my life neurologist appointment 6months after first visit ,now that’s wrong as I like to know what’s going on in my head seeing my GP in October and will tell I’ve had to adjust time myself ,I have also had pain again and took so many Tegretol as told 800mgs they made me feel very weak and out of it pain did subside I would now say very painful ,so maybe they will be easier,im 80 yrs old and want to carry on with the sport so yes trying the best way to take this Tegretol.

After being on antibiotics, you need to see if you have fungal or parasitic infections. I unfortunately can’t answer your other questions, but there’s a very good chance your headaches are caused or partially caused by fungal and parasitic infections.

just saw your question.
I have been taking tegretol since 1984 with success.
Ibuprofen is not a problem. I only avoid E-micin antibiotic, birth control pills, and grapefruit juice. I just discovered I won’t be using St John’s Wort either.

I am 71 years old and am blessed with very good health with the exception of a petite mall epilepsy that I began to experience in my late 20s. It was caused by scar tissue on my frontal brain lobe because of difficult birth. I have been taking various meds to find out which was best.
For the last 35 years I have taken tegretol with little or no side affects other than a little unsteadiness when I first started it. I switched over to the generic “carbamazepine ” about 10 years ago. My blood work up is normal. My blood pressure becomes elevated when I don’t exercise, my weight is normal and I have developed peripheral neuropathy in my toes within the last 2 years.

I am taking 1600mg of Tegretol for trigrminal neuralgia and it does not completely stop the shocks or burning pain. I have trembling hands and find it difficult to type. Do not drink alcohol as it makes this trembling worse. The side effects and lack of pain control make this drug not an option for me though I wish it worked.

I am currently taking 800mg/day Tegretol and 1200mg of gabapentin for trigeminal neuralgia and it has helped my pain tremendously. While I tritated to the 800mg Tegretol, it took my body a few days to get used to the drug, but I feel fine now. I did recently strain the muscle in my upper arm and would like to take either Advil or Tylenol for the pain. Any issues with doing that?

I have been taking carbamazepine for trigemilal neuralgia for about3 months. I also take amitriptyline for fibromylasia. My Dr. prescribed both of these. My insurance company notified her I could not take both. What side effect do they have together and why would she order both knowing they don’t go together?

I have taken various forms of Tegretol for roughly the past 20 years for control of seizures. For me, it has been effective with relatively few side effects. As far as ibuprofen, I have never been advised to avoid it, and was at one point taking 1200mg per day of ibuprofen by prescription after an injury.

My partner has been admitted to hospital with Stevens Johnson Syndrome 2 weeks after taking Tegretol she is over 50 and of Asian background, very serious side-effects, skin rash and mouth blisters

I take Tegretol for Trigeminal Neuralgia. Do you know of any alternative treatments?
St. Johns wort has been recommended, but I read on your website that it may reduce the effectiveness of Tegretol.

I take carbamazipine and want to know if I can use Ibuprofen for arthritis. I get it periodically and use 800 milligrams once per day about 2-3 timer per month and it works great. Is this ok to use along with carbamazepine?

I take 800 mg of carbamazepine a day AND 60 MG of baclofen a day for trigeminal neuralgia a day. I have the side effects of unsteadiness, shaking of my hands, crying, pulsating through my body, prickly face. I am afraid to drive, but need to. My reflexes are not correct. I need to take this much medicine to stop the pain in my left jaw. What can be done?

will it be safe to take ibuprofen for headache while taken tegretol?

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